Informacja

Drogi użytkowniku, aplikacja do prawidłowego działania wymaga obsługi JavaScript. Proszę włącz obsługę JavaScript w Twojej przeglądarce.

Tytuł pozycji:

Progression of the first stage of spontaneous labour: A prospective cohort study in two sub-Saharan African countries.

Tytuł:
Progression of the first stage of spontaneous labour: A prospective cohort study in two sub-Saharan African countries.
Autorzy:
Olufemi T Oladapo
Joao Paulo Souza
Bukola Fawole
Kidza Mugerwa
Gleici Perdoná
Domingos Alves
Hayala Souza
Rodrigo Reis
Livia Oliveira-Ciabati
Alexandre Maiorano
Adesina Akintan
Francis E Alu
Lawal Oyeneyin
Amos Adebayo
Josaphat Byamugisha
Miriam Nakalembe
Hadiza A Idris
Ola Okike
Fernando Althabe
Vanora Hundley
France Donnay
Robert Pattinson
Harshadkumar C Sanghvi
Jen E Jardine
Özge Tunçalp
Joshua P Vogel
Mary Ellen Stanton
Meghan Bohren
Jun Zhang
Tina Lavender
Jerker Liljestrand
Petra Ten Hoope-Bender
Matthews Mathai
Rajiv Bahl
A Metin Gülmezoglu
Temat:
Medicine
Źródło:
PLoS Medicine, Vol 15, Iss 1, p e1002492 (2018)
Wydawca:
Public Library of Science (PLoS), 2018.
Rok publikacji:
2018
Kolekcja:
LCC:Medicine
Typ dokumentu:
article
Opis pliku:
electronic resource
Język:
English
ISSN:
1549-1277
1549-1676
Relacje:
https://doaj.org/toc/1549-1277; https://doaj.org/toc/1549-1676
DOI:
10.1371/journal.pmed.1002492
Dostęp URL:
https://doaj.org/article/2a43d12475414f5caf3924867856a7ad  Link otwiera się w nowym oknie
Numer akcesji:
edsdoj.2a43d12475414f5caf3924867856a7ad
Czasopismo naukowe
BackgroundEscalation in the global rates of labour interventions, particularly cesarean section and oxytocin augmentation, has renewed interest in a better understanding of natural labour progression. Methodological advancements in statistical and computational techniques addressing the limitations of pioneer studies have led to novel findings and triggered a re-evaluation of current labour practices. As part of the World Health Organization's Better Outcomes in Labour Difficulty (BOLD) project, which aimed to develop a new labour monitoring-to-action tool, we examined the patterns of labour progression as depicted by cervical dilatation over time in a cohort of women in Nigeria and Uganda who gave birth vaginally following a spontaneous labour onset.Methods and findingsThis was a prospective, multicentre, cohort study of 5,606 women with singleton, vertex, term gestation who presented at ≤ 6 cm of cervical dilatation following a spontaneous labour onset that resulted in a vaginal birth with no adverse birth outcomes in 13 hospitals across Nigeria and Uganda. We independently applied survival analysis and multistate Markov models to estimate the duration of labour centimetre by centimetre until 10 cm and the cumulative duration of labour from the cervical dilatation at admission through 10 cm. Multistate Markov and nonlinear mixed models were separately used to construct average labour curves. All analyses were conducted according to three parity groups: parity = 0 (n = 2,166), parity = 1 (n = 1,488), and parity = 2+ (n = 1,952). We performed sensitivity analyses to assess the impact of oxytocin augmentation on labour progression by re-examining the progression patterns after excluding women with augmented labours. Labour was augmented with oxytocin in 40% of nulliparous and 28% of multiparous women. The median time to advance by 1 cm exceeded 1 hour until 5 cm was reached in both nulliparous and multiparous women. Based on a 95th percentile threshold, nulliparous women may take up to 7 hours to progress from 4 to 5 cm and over 3 hours to progress from 5 to 6 cm. Median cumulative duration of labour indicates that nulliparous women admitted at 4 cm, 5 cm, and 6 cm reached 10 cm within an expected time frame if the dilatation rate was ≥ 1 cm/hour, but their corresponding 95th percentiles show that labour could last up to 14, 11, and 9 hours, respectively. Substantial differences exist between actual plots of labour progression of individual women and the 'average labour curves' derived from study population-level data. Exclusion of women with augmented labours from the study population resulted in slightly faster labour progression patterns.ConclusionsCervical dilatation during labour in the slowest-yet-normal women can progress more slowly than the widely accepted benchmark of 1 cm/hour, irrespective of parity. Interventions to expedite labour to conform to a cervical dilatation threshold of 1 cm/hour may be inappropriate, especially when applied before 5 cm in nulliparous and multiparous women. Averaged labour curves may not truly reflect the variability associated with labour progression, and their use for decision-making in labour management should be de-emphasized.
Zaloguj się, aby uzyskać dostęp do pełnego tekstu.

Ta witryna wykorzystuje pliki cookies do przechowywania informacji na Twoim komputerze. Pliki cookies stosujemy w celu świadczenia usług na najwyższym poziomie, w tym w sposób dostosowany do indywidualnych potrzeb. Korzystanie z witryny bez zmiany ustawień dotyczących cookies oznacza, że będą one zamieszczane w Twoim komputerze. W każdym momencie możesz dokonać zmiany ustawień dotyczących cookies